Abstract Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial. Objective To identify the clinical and pathological factors predictive of tumor recurrence. Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the AmericanThyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence. Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95% CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95% CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients. Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age <55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.

Abstract Introduction Postoperative neck hematoma (PNH) is an uncommon but potentially-lethal complication of thyroid surgery. Objective To identify the risk factors for postthyroidectomy hematoma requiring reoperation, the timing, the source of the bleeding, the related respiratory distress requiring tracheotomy, and the late outcomes. Methods We retrospectively analyzed the records of 5,900 consecutive patients submitted to surgery for thyroid diseases at a single institution. Results In total, PNH occurred in 62 (1.1%) patients. Most cases of bleeding occurred within the first 6 hours after thyroidectomy, but 12.5% of the hematomas were observed after 24 hours. Obvious bleeding points were detected in 58.1% of the patients during the reoperation, with inferior thyroid artery branches and superior thyroid vessels being the most frequent bleeding sources. Only two patients required urgent tracheostomy. There were no hematoma-related deaths. Permanent hypoparathyroidism and recurrent laryngeal nerve injury are more frequent following reoperation for PNH. The factors significantly associated with PNH were: older age, concurrent lymph node dissection, and chronic lymphocytic thyroiditis. Gender, previous neck irradiation, presentation at diagnosis (symptomatic or incidental), substernal goiter, thyroidectomy for hyperthyroidism, prior thyroid surgery, malignant histology, the extent of the surgery (total versus non-total thyroidectomy), the use of energy-based vessel sealing devices, the use of the hemostatic agent Surgicel, and the placement of a surgical drain were not significantly associated with PNH. Conclusion Hematoma after thyroid surgery is an uncommon complication, but it is related to significant postoperative morbidity. A better understanding of the risk factors and of the time until hematoma formation can help target high-risk patients for preventive measures and closer postoperative observation.

O carcinoma de Células de Merkel constitui neoplasia cutânea maligna, rara e grave, de origem neuroendócrina, com comprometimento linfonodal em metade dos pacientes e metástases disseminadas em 20% quando do diagnóstico anatomopatológico. Seu tratamento não está completamente estabelecido, entretanto a pesquisa do linfonodo sentinela vem sendo considerada indispensável e pode trazer benefícios na condução terapêutica dos pacientes.

The Merkel cell carcinoma is a rare, serious, neuroendocrine, malignant skin cancer with lymph node involvement in half of patients and disseminated metastases in 20% of cases at the time of pathological diagnosis. Its treatment is not fully established, though the sentinel lymph node has been considered essential and may bring benefits to the therapeutic armamentarium of patients.

INTRODUÇÃO: Tumores sólido-cístico papilares têm sido reconhecidos como uma doença neoplásica distinta, cuja incidência tem aumentado atualmente em decorrências dos avanços em imaginologia. RELATO DO CASO: Mulher de 17 anos, procurou atendimento médico em virtude de uma massa homogênea sólido-cística em cauda pancreática, e foi submetida a pancreatectomia distal com preservação do baço, apesar da excisão dos vasos esplênicos. Avaliação histológica revelou protrusões pseudopapilares revestidas de epitélio, sem degeneração maligna. A evolução clínica pós-operatória ocorreu sem complicações. CONCLUSÃO: Estes tumores têm que ser reconhecidos pelos clínicos, patologistas e radiologistas, e cirurgicamente ressecados com preservação do baço, conquanto apresentam prognóstico favorável.

BACKGROUND: Solid papillary-cystic pancreatic tumors have been recognized as a distinct neoplastic disease, whose incidence has increased in recent years with advancements in imaging technology. CASE REPORT: Woman 17-year-old consulted with a symptomatic giant homogeneous solid-cystic mass in the pancreatic tail, undergone a spleen preserving distal pancreatectomy, with excision of the splenic vessels. Histopathology revealed epithelium-lined pseudopapillary protrusions, without malignant change. The patient's postoperative course was uneventful. CONCLUSION: Solid papillary-cystic pancreatic tumor has uncommon incidence and silent presentation, a high degree of suspicion on the part of the surgeon is warranted. In early diagnosis, complete resection is curative. The spleen should be preserved, if feasible.

INTRODUÇÃO: Apesar dos refinamentos em cirurgia gastrointestinal, vazamentos anastomóticos persistem como grave problema, associados à morbidade e mortalidade elevadas e constituem a complicação mais temida. Na tentativa de prevenir e reduzir estas complicações, diversidade de técnicas de reforço anastomótico tem sido investigada e diversas medidas auxiliares têm sido desenvolvidas. OBJETIVO: Revisar os dados associados a aplicação de adesivos em cirurgia digestiva. MÉTODO: Revisão bibliográfica de artigos disponíveis no Medline/Pubmed utilizando-se os descritores: adesivo, trato gastrointestinal, anastomose cirúrgica e fístula. Foram selecionados os artigos mais atualizados sobre o assunto os quais utilizaram adesivos como estratégia para reduzir a morbidade e mortalidade relacionada à cirurgia digestiva. CONCLUSÃO: Adesivos teciduais parecem seguros na prática clínica e têm sido utilizados com crescente frequência em várias especialidades cirúrgicas em decorrência de suas propriedades hemostáticas e selante, ganhando cada vez maior aceitação por parte dos cirurgiões. Estudos sugerem que adesivos cirúrgicos podem reforçar e melhorar a cicatrização de anastomoses intestinais, elevando a pressão de ruptura e aumentando a força tênsil. Os potenciais efeitos deletérios teciduais destas substâncias podem limitar sua utilização. Em decorrência da heterogeneidade dos estudos e falta de evidência forte, novas pesquisas deverão ser desenvolvidas.

BACKGROUND: Despite refinements in the field of gastrointestinal surgery, anastomotic leakage still remains a serious problem associated with substantial morbidity and mortality and is the fearest life threatening complication in digestive surgery. To prevent or reduce these complications, a diversity of line reinforcement techniques have been investigated and several adjunctive measures have been developed. AIM: To review the data associated with the application of adhesives in digestive surgery procedures. METHOD: Review of papers available at Medline/Pubmed database using the follow headings: adhesive, gastrointestinal tract, surgical anastomosis, fistula. It was chosen recent articles on the subject which showed adhesives as strategy to reduce morbidity and mortality related to digestive surgery. CONCLUSION: Tissue adhesives appears to be safe in the clinical setting and are been used with increasing frequency in a variety of surgical field for its unique hemostatic and adhesive abilities, gaining increasing acceptance among surgeons. Studies suggest that surgical adhesive can be useful to reinforce and improve intestinal anastomotic healing, increase anastomotic bursting pressures and tensile strength. The potentially harmful tissue effects of the preparations might compromise the use of these substances. Because of the heterogeneity and lack of high level evidence, new studies have to be performed.